| NPI | 1861698524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHEILA NEWMAN Associate Operations Manager 307-789-4224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| 291U00000X Clinical Medical Laboratory | |
| Enumeration Date | 2007-06-21 |
| Last Update Date | 2022-08-30 |